Substance abuse in adolescents.

Liddle, H. A., & Rowe, C. L. (2006). Adolescent substance abuse. Research and clinical advances. Cambridge, UK: Cambridge University Press. [Hardbound; ISBN# 0-521-82358-7; $120.00]

In United States, substance use and abuse among adolescent population accounts for significant morbidity and mortality (Schydlower, 2002). Alcohol and tobacco are the usual drugs of choice among adolescents, followed by marijuana, stimulants, hallucinogens and inhalants (Brown, 2002). The purpose of this book is to provide information about the research and clinical advances pertaining to substance abuse in adolescents. The book is intended for practitioners, program planners, and policy makers.

The book is organized into twenty two chapters in six parts. The first chapter is on the overview of treating adolescent substance abuse that explains the layout of the book. The first part that follows the first chapter is about theoretical, empirical, and methodological foundations for research into treatment of adolescent substance abuse and contains four chapters. The first chapter of part one is on developmental context for adolescent substance abuse intervention. The chapter identifies the risk factors and protective factors related to adolescent drug use and uses the family interactional theory. Implications for individual level treatment, family level treatment, group treatment, and community approaches are discussed. The second chapter of part one discusses a latent variable growth modeling framework. The third chapter of part one describes the clinical course of youth following alcohol and drug treatment. The chapter discusses differences between adolescent and adult relapse patterns, and special challenges for youth treatment programs. The cognitive behavior model based on Marlatt and Gordon (1980) is presented as the process for relapse for adolescents. Identification of factors that predict success for adolescents following drug and alcohol treatment programs are an important contribution of this chapter. The last chapter of part one is about cannabis youth treatment intervention. Cannabis is an important psychoactive compound used by adolescents (Hall & Babor, 2000). The chapter discusses different treatments such as motivational enhancement treatment, family support network, and multidimensional family therapy and seems authoritative in the area.

The second part of the book is about practice and policy trends related to treatment of adolescent substance abuse and is divided into five chapters. The first chapter in the second part is about epidemiological trends of adolescent substance abuse in Europe. Data about prevalence of substance abuse in Europe and specific European countries is presented. Up-to-date information is presented. The second chapter in the second part is about adolescent drug abuse treatment outcome studies. Drug Abuse Reporting Program (DARP), Treatment Outcome Perspectives Study (TOPS), and Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A) from United States are discussed. Such programs are important for dissemination of treatment protocols for grassroots efforts. The third chapter in the second part is about the context of adolescent treatment services. Systems of care, providers of care, financing mechanisms, technology transfer and quality issues are discussed. The fourth chapter in the second part is about England and describes the legal framework and policy context and the pattern of resources that identify how services respond to adolescents with substance abuse problem. Some useful lessons for the systems in America and elsewhere in the world have been discussed. The last chapter in the second part identifies key findings and highlights the gaps in existing health services research with drug abusing adolescents. The chapter is organized around the key care components of health services research as identified by Institute of Medicine (2001), namely, effective, patient centered, timely, efficient, equitable, and redesigned.

The third part is about comprehensive assessment and integrative treatment planning with adolescent substance abusers and is organized into four chapters. The first chapter in the third part provides an overview of clinical best practices for assessing adolescent drug abuse. The chapter proposes a multidimensional model of screening and assessment that is relevant for problem identification, referral, and treatment. The highlights of this chapter are the guidelines for substance abuse treatment placement starting from brief interventions (2-4 sessions) to low-intensive treatment (7-20 sessions) to intensive treatment (more than 21 sessions). The second chapter in the third part pertains to psychopharmacology of adolescents with substance abuse problem. The current status of pharmacotherapy, lessons from adult literature, pharmacological treatment studies in adolescents, pharmacological treatment of comorbid conditions and future directions for research are discussed in this chapter. The third chapter in the third part enhances understanding about clinical impact and treatment implications of comorbidity in adolescents with substance abuse problem. Developmental context of comorbid psychiatric disorders with substance abuse, assessment issues, and clinical approach are discussed in detail. This chapter is useful both for practitioners and researchers. The last chapter in the third part focuses on HIV infection in adolescent substance abusers. It discusses patterns of HIV risk and substance abuse in adolescents and different interventions at the individual level, small group level, family level, and community level.

The fourth part is about empirically-tested interventions for substance abuse in adolescents and has five chapters. This section is clearly the backbone of the book. The first chapter in this part is around the topic of therapeutic communities. Background, history, empirical basis, the prototypical adolescent therapeutic community, and methodological, clinical, and policy issues with therapeutic communities are discussed in the chapter. The second chapter in the fourth part is about school-based interventions and student assistance programs are discussed. The third chapter in the fourth part is about behavioral and family interventions. The fourth chapter is about behavioral management approaches and discusses behavior analysis and principles of contingency management. The last chapter in the fourth part is about cognitive-behavioral therapies. The underlying theoretical models, evidence from randomized controlled trials, and applications for comorbid conditions are discussed in this chapter.

The fifth part of this book is about culturally-based interventions for adolescent substance abusers and has two chapters. The first chapter is about family centered treatment for American Indian adolescent substance abuse. The American Indian communities are described along with family-centered intervention and results from evaluation. The second and last chapter in this section is about family-based treatment in Hispanic adolescents. The emphasis on cultural competence is the highlight of this chapter.

The sixth and final part has only one chapter and focuses on the future. The chapter points at the need to decrease the gap between research and practice, the need to disseminate research findings, enhance access to evidence-based approaches, expand the role of juvenile justice system, and confront the challenges posed by HIV/AIDS epidemic.

The book is a valuable resource for practitioners, researchers, and policy makers in the area of substance abuse particularly those working with adolescents. It is also useful for graduate students in health, education, social work, counseling, addictive behaviors, sociology and psychology who are studying treatment aspects of substance abuse. The book has been written by several contributors which add to the flavor of the book. On the whole, this monograph will serve as an important book in this area.

REFERENCES

Brown, R. T. (2002). Risk factors for substance abuse in adolescents. Pediatric Clinics of North America, 49 (2), 247-255.

Hall, W., & Babor. T.F. (2000). Cannabis uses and public health: assessing the burden, Addiction, 95, 485-490.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st Century. Washington, DC: National Academy Press.

Marlatt, G.A., & Gordon, J. R. (1980). Determinants of relapse: Implications for the maintenance of behavior change. In P. Davidson, & S.M. Davidson (eds.), Behavioral medicine: Changing health lifestyles (pp. 410-452). Elmsford, NY: Pergamon.

Schydlower, M. (2006). Adolescent substance use and abuse: Current issues. Texas Medicine, 98(2), 31-35.

Review by Manoj Sharma, University of Cincinnati